Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...
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Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

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67253066<strong>01</strong>0 PYRAZINAMIDE TAB 500MG 12/31/9999 2<strong>01</strong>2367253066050 PYRAZINAMIDE TAB 500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>153511<strong>01</strong> PYRIDOSTIGM TAB 60MG 12/31/9999 2<strong>01</strong>23007815<strong>01</strong>5<strong>01</strong> PYRIDOSTIGM TAB 60MG 02/28/2<strong>01</strong>3 2<strong>01</strong>2364720<strong>01</strong>2810 PYRIDOSTIGM TAB 60MG 12/31/9999 2<strong>01</strong>23680840494<strong>01</strong> PYRIDOSTIGM TAB 60MG 12/31/9999 2<strong>01</strong>2368682030210 PYRIDOSTIGM TAB 60MG 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>80<strong>01</strong> PYRIDOXINE INJ 100MG/ML 12/31/9999 2<strong>01</strong>23005364409<strong>01</strong> PYRIDOXINE TAB 100MG 12/31/9999 2<strong>01</strong>23005364406<strong>01</strong> PYRIDOXINE TAB 25MG 12/31/9999 2<strong>01</strong>23617480092<strong>01</strong> PYRIDOXINE TAB 25MG 12/31/9999 2<strong>01</strong>2361748009210 PYRIDOXINE TAB 25MG 12/31/9999 2<strong>01</strong>2361748009230 PYRIDOXINE TAB 25MG 12/31/9999 2<strong>01</strong>23617480095<strong>01</strong> PYRIDOXINE TAB 50MG 12/31/9999 2<strong>01</strong>2361748009510 PYRIDOXINE TAB 50MG 12/31/9999 2<strong>01</strong>2361748009530 PYRIDOXINE TAB 50MG 12/31/9999 2<strong>01</strong>2344183020816 PYRIL D SUS 16-5MG/5 12/31/9999 2<strong>01</strong>2344183021<strong>01</strong>6 PYRIL DM SUS 12/31/9999 2<strong>01</strong>2351552061705 PYRIMETHAMIN POW 12/31/9999 2<strong>01</strong>2351552061707 PYRIMETHAMIN POW 12/31/9999 2<strong>01</strong>2351552074404 PYRUVIC ACID LIQ 12/31/9999 2<strong>01</strong>2351552074405 PYRUVIC ACID LIQ 12/31/9999 2<strong>01</strong>2363868098903 QC ALCOHOL PAD SWABS 12/31/9999 2<strong>01</strong>2363868<strong>01</strong>3214 QC ALLERGY TAB 10MG 12/31/9999 2<strong>01</strong>2363868<strong>01</strong>3230 QC ALLERGY TAB 10MG 12/31/9999 2<strong>01</strong>2363868<strong>01</strong>3290 QC ALLERGY TAB 10MG 12/31/9999 2<strong>01</strong>2363868098124 QC ALLERGY TAB RELIEF 12/31/9999 2<strong>01</strong>2363868098524 QC ALLERGY/ TAB SINUS 12/31/9999 2<strong>01</strong>2363868069457 QC ANTACID SUS 12/31/9999 2<strong>01</strong>2363868071257 QC ANTACID SUS ANTI-GAS 12/31/9999 2<strong>01</strong>2363868071557 QC ANTACID SUS ANTI-GAS 12/31/9999 2<strong>01</strong>23638680089<strong>01</strong> QC ARTHRITIS TAB 650MG CR 12/31/9999 2<strong>01</strong>2363868008950 QC ARTHRITIS TAB 650MG CR 12/31/9999 2<strong>01</strong>2363868035203 QC ASPIRIN TAB 325MG 12/31/9999 2<strong>01</strong>2363868035210 QC ASPIRIN TAB 325MG 12/31/9999 2<strong>01</strong>2363868091410 QC ASPIRIN TAB 325MG EC 12/31/9999 2<strong>01</strong>2363868<strong>01</strong>0032 QC AZO TAB 95MG 12/31/9999 2<strong>01</strong>2363868062660 QC CALCIUM TAB 600MG 12/31/9999 2<strong>01</strong>2363868063060 QC CALCIUM TAB 600MG 12/31/9999 2<strong>01</strong>2363868032206 QC CASTOR OIL 12/31/9999 2<strong>01</strong>2363868006904 QC CGH RELF LIQ 15MG/5ML 12/31/9999 2<strong>01</strong>2363868007004 QC CGH RELF LIQ 15MG/5ML 12/31/9999 2<strong>01</strong>2363868024136 QC CHILD ASA CHW 81MG 12/31/9999 2<strong>01</strong>2363868062960 QC CHILDRENS CHW COMPLETE 12/31/9999 2<strong>01</strong>2363868061660 QC CHILDRENS CHW EXTRA C 12/31/9999 2<strong>01</strong>2363868062860 QC CHILDRENS CHW IRON 12/31/9999 2<strong>01</strong>2363868050624 QC COLD TAB RELIEF 12/31/9999 2<strong>01</strong>2363868006304 QC COLD RELF SUS PLUS MS 12/31/9999 2<strong>01</strong>2363868076306 QC COLD/CGH POW DAYTIME 12/31/9999 2<strong>01</strong>2363868076406 QC COLD/CGH POW NIGHTTIM 12/31/9999 2<strong>01</strong>2363868007524 QC COLD/HEAD TAB DAYTIME 12/31/9999 2<strong>01</strong>2363868007424 QC COLD/HEAD TAB NIGHTTIM 12/31/9999 2<strong>01</strong>2363868006508 QC COUGH LIQ SORE THR 12/31/9999 2<strong>01</strong>2363868038620 QC DAYTIME CAP COLD/FLU 12/31/9999 2<strong>01</strong>2363868033912 QC DIARRHEA SUS RELIEF 12/31/9999 2<strong>01</strong>2363868038045 QC ENEMA ENE 12/31/9999 2<strong>01</strong>2363868038090 QC ENEMA ENE 12/31/9999 2<strong>01</strong>2363868093704 QC EPSOM GRA SALT 12/31/9999 2<strong>01</strong>2363868093716 QC EPSOM GRA SALT 12/31/9999 2<strong>01</strong>23638680623<strong>01</strong> QC ESSENTIAL TAB 12/31/9999 2<strong>01</strong>23

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